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Overseas information: www.cdc.gov/ncidod/diseases/Index.htm
The Disease: - This disease is characterised by high fever (onset 5-21 days), abdominal pain with or without diarrhoea,
enlarged spleen (3dr week) and rose coloured spots confined to chest & abdomen. It can infect the
blood (septicaemia) which has a fatality rate of 10 - 20 % if untreated & 1%
in treated persons. The risk of infection is generally low, approximately 1 in
30,000 for travellers to developing countries spending 4 weeks. Risk is 10 times
higher in parts of India, Africa & South America. Typhoid is generally a
milder illness in children under 5. Risk is increased by failing to
observe hygiene ... cook it, peel it or forget it !
recommendation: - For anyone travelling to developing countries where the
food and water quality is uncertain and persons with impaired gastric acid or
immune deficiency. Most
travel clinics do not recommend vaccine for travellers spending less than 2
weeks in popular tourist resorts. However, you can request to be vaccinated
& the vaccine is well tolerated, (but expensive).
Vaccination: .. CDC Vaccine
information statement .. copy (see also CMI pdf)
Capsules: "CSL-Vivotif(R) Oral", on alternate days,
1 hour before food for 3-4
doses. A 4th dose on day 7 has been estimated to increase immunity by an
extra 40%. Boosters every 3-5 years depending on regime. Clinical disease is
uncommon in children under 2 years of age. Vaccine can be given in children over the age
of 6 years. Some medicines and "Vivotif(R) Oral", may interfere
with each other. These include: sulphonamides, antibiotics &
antimalarials. [ Nb. mefloquine, chloraquine and malarone do not interfere
with IgG O immune response BUT it is still recommended that they should be taken at least 1 week after the (final) dose of "Vivotif(R)
Oral" (WHO recommends 10 days) ]. Oral typhoid capsules should be stored in the
refrigerator (not freezer - as this will inactivate vaccine) until taken. Contrary to
NHMRC guidelines, it is argued that other live vaccines, Sabin, MMR, yellow
fever and oral cholera vaccine can be given at the same time as
oral typhoid. Oral cholera vaccine is actually enhanced by giving it with
oral typhoid. ref: page 123 Manual
Injection - Typhim Vi polysaccharide vaccine (CSL) & Typherix
is estimated to be as effective as the 4 dose oral typhoid provided the oral
typhoid capsules are given with adherence to the above recommendations (approx 70 - 80% effective).
A single injection is simple, immune response quicker and
can be used in children over 2 years. - booster every 3 years.
Typhoid Fever (enteric fever)
A bacterial infection characterised by diarrhoea, systemic disease, and a rash; most
commonly caused by Salmonella typhi.
Typhi are spread by contaminated food, drink, or water. Following ingestion, the bacteria
spread from the intestine to the intestinal lymph nodes, liver, and spleen via the blood
where they multiply. Salmonella may directly infect the gallbladder through the hepatic
duct or spread to other areas of the body through the bloodstream.
Early symptoms are very general and include fever, malaise and abdominal pain. As the
disease progresses the fever becomes higher and diarrhoea becomes prominent and may be
bloody. Weakness, profound fatigue, delirium, blood noses, obtundation(swollen abdomen)
develop. A rash, characteristic only of typhoid and called "rose spots," appears
in most cases of typhoid. Rose spots are small (1/4 inch) dark red, flat spots that appear
most often on the abdomen and chest. Typically, children have milder disease and fewer
complications than adults. A few people can become carriers of typhoid and continue to
shed the bacteria in their faeces for years.
Immunisation is not always completely effective and at-risk travellers should
drink only boiled or bottled water and eat well cooked food.
SIGNS AND TESTS
A blood culture during first week of the fever can show Salmonella typhi
bacteria. Note: A stool culture is unreliable.
- platelet count (decreased platelets)
- fluorescent antibody study (demonstrates Vi antigen, which is specific for typhoid)
Intravenous fluids and electrolytes are usually given. Appropriate antibiotics
are given to fight the bacteria; (preferred is ceftriaxone - ciprofloxacin, chloramphenicol resistance common).
The illness usually resolves in 2 to 4 weeks with treatment. The outcome is likely to be
good with early treatment, but becomes poor if complications develop. Cases in children
are milder, and are more debilitating in the elderly. Relapse may occur if the treatment
has not fully eradicated the infection.
See Also New York Health Department sheet
Information mostly taken from: "International
Travel and Health" (WHO year book -
Australian Immunisation Handbook, 8th Edition - 9/2003 - Part1 - Part 2 & Part 3 (large pdf
Centre for Disease Control, USA - www.cdc.gov/travel Travel Health Seminar Oct 96, June 97,Feb 98, March 99, May 2000, August 2002 &
March 2005 - Victorian Medical Postgraduate Foundation.
Manual of Travel Medicine,
Melbourne, Oct 2004.
Updated 06/09/2006. Additional references & disclaimer.